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PMT17-04290 City of Menifee Permit No.: PMT17-04290 29714 HAUN RD. 't;�jCCQL_/-> MENIFEE,CA 92586 Type: Residential Plumbing MENIFEE Date Issued: 12/04/2017 PERMIT Site Address: 32335 LINDENBERGER RD,MENIFEE, Parcel Number: 372-140-015 CA 92584 Construction Cost: $5,000.00 Existing Use: Proposed Use: Description of LEACH LINE REPLACEMENT 3 CHAMBERS 60'FEET LONG Work: RIVERSIDE COUNTY APPROVAL 11/29/07 Owner Contractor GLEN SORUM LANIK ENTERPRISES INC 32335 LINDENBERGER RD P 0 BOX 891416 TEMECULA,CA 92589 Applicant Phone:9516767114 LANIK ENTERPRISES INC License Number.458947 P 0 BOX 891416 TEMECULA,CA 92589 Fee Description Qtv Amount($1 Sewer 1 150.00 Building Permit Issuance 1 27.00 GREEN FEE 1 1.00 SMIP RESIDENTIAL 1 1.00 General Plan Maintenance Fee-Plumbing 1 7.50 $186.50 The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and specifications or from preventing builiding operations being carded on thereunder when in violation of the Building Code or of any other ordinance of City of Marilee.Except as otherwise stated,a permit for construction under which no work is commenced within six months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be forfeited. AA_Bldg_Permit_Template.rpt Page 1 of 1 CITY OF MENIFEE LICENSED DECLARATION property who builds or Improves thereon,and who contracts for the projects With a licensed contractor(s)pursuant to the Contractors State License Law). I hereby affirm under penalty of perjurythat I am under provisions of Chapter9(commencing with section 7000)of Division 3 of the Business and o I am exempt from Iicensure.under the Contractor's State License Law for Professions Code and my license is In full force and effect. the fallowing reason: License Class 0&8 C�License No. By my signature below I acknowledge that,except for my personal residence Expires Signature in which I must have resided for at least one year prior to completion of 4�11improvements covered by this permit.)cannot legally sell a structure that I WORKER'S COMPENSATION DECLARATION have built as an owner-builder If It has not been constructed in its entirety by ❑I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section have and will maintain a certificate of consent of self-insure for worker's 7044 of the Business and Professions Code,is available upon request when compensation,Issued by the Director of Industrial Relations as provided for this application Is submitted or at the following website: by Section 37DO of the Labor Code,for the performance of work for which �yyy�y,leeinfo.ca.eov/calaw.html. this permit is issued. Policy q Date ❑I have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT section 3700 of the Labor Code,for the performance of the work for which pray my signature below I certify to each of the following:I am the property this permit is issued.My workers compensation insurance carder and policy owner or authorized to act on the property owners behalf.I have read this number are: application and the information I have provided is correct.1 agree to comply Carrier with all applicable city and county ordinances and state laws relating to �J building construction.I authorize representatives of this city or county to Policyri �� ��'�ff l? entert eab eidentffied ropertyf r inspection purposes. (This section need not to be completed is the permit Is for one-hundred r Z —/ dollars($100)or less Date PROPERTY OWNPZR AUTHORIZED AGENT o 1 certify that in the performance of the work for which this permit Is issued, I shall not emolov any persons in any manner so as to become subject to the CITY BUSINESS LICENSE ft workers compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION subject to the workers compensation provisions of Section 3700 of the Labor Code,I shall fo I( ith co ly with tnhw provis')ns. Will the applicant or future building occupant handle hazardous material or a Applicant r Date �Z"-]'— mixture containing a hazardous material equal to or greater that the amounts specified on the Hazardous Materials Information Guide? WARNING:FAILURE TO SECUR ORKER'S COMPENSATION COVERAGE IS o Yes pNo UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($300,000),IN occupant require a permit for the construction or modification from South ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES for guidelines CONSTRUCTION LENDING AGENCY ❑Yes Wvo I hereby affirm that under the penalty of perjury there is a construction WIII the proposed building or modified facility be within 1000 feet of the lending agency for the performance of the work which this permit is issued outer boundary of a school? (Section 3097 Civil Code) 0 Yes OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD permitting checklist.I understand my requirements under the State of I hereby affirm under penalty of perjurythat I am exempt from the California Health&Safety Code,Section 25505 and 25534 concerning Contractors License Law for the reason(s)indicated below by the hazardous material reporting. checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oyes �IPo , _ Business and Professions Code).Any city or county that requires a permit to Date- 2 4 /� construct,alter,improve,demolish or repair any structure,prior to its pR RTY OWNER AUTHORIZED AGEM Issuance,also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION,REPAIR AND PAINTING(RRP) Ucense Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint In a pre-1978 and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property than($500). managers who do the paint-disturbing work themselves or through their ❑I,as owner of the property,or my employee with wages as their sole employees.For more information about EPAN Renovation Program Visit: compensation,will do( )all of or( )portion of the Work,and the structure Is www.eoa.eov/lead or contact the National Lead Information Center at not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323). Code;The Contractors State License Law does not apply to an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project property who,through employees'or personal effort,builds or Improves the property provided that the Improvements are not intended or offered for Certified Firm Name: sale.If,however,the building or Improvement is sold within one year of Firm Certification No.: completion,the Owner-Builder will have the burden of proving that it was not built or improved for the purpose of sale. ❑No EPA Lead-Safe Certified Firm is required for this project because: ❑I,as owner of the property am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP Acknowledgement. BUILDING & SAFETY PERMIT/PLAN CHECK APPLICATION g 'Menifee DATE: it � PERMIT/PLAN CHECK NUMBER TYPE: O COMMERCIAL ® RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA O SIGN SUBTYPE: O ADDITION O ALTERATION O DEMOLITION O ELECTRICAL O MECHANICAL O NEW 6 PLU�MBING O RE-ROOF NUMBER OF SQUARES DESCRIPTION OF WORK L.E-�/-1.-� vot PROJECTADDRESS ZIP ASSESSOR'S PARCEL NUMBER I/`,-lib OT TRACT OWNERNAME V/ rv-% ADDRESS LA ndey) b/ce v- PHONE �� �� r /�'i�j EMAIL APPLICANT NAME,, C ADDRESS V 1 (o :kmctcu A 0/ PHONE EMAIL 1 . IGY� CONTRACTOR'S NAME v , S OWNER BUILDER? O YES ®NO BUSINESS NAME \I M1- �P/VJJ, � yl �J ADDRESS I I,VJ 2S8 PHONE EMAIL r I o I Cl (J M CONTRACTOR'SSTAAT�T++E LIC NUMBER 4�gjej LAJ LICENSE CLASSIFICATION Ig VALUATION$ �,/ee>OOI D SQ FT L SQ FT APPLICANT'S SIGNATURE DATE CITYSTAFF USE ONLY _ DEPARTMENT DISTRIBUTION CRY OF MENIFEE BUSINESS LICENSE NUMBER BUILDING PLANNING ENGINEERING FIRE ACCEPTED BY: PERMIT FEE SMIP GREEN PLAN CHECK FEE INVOICETOTAL OWNER BUILDER VERIFIED _:.YES 0 NO DRIVERS LICENSE## NOTARIZED LETTER O YES O NO City of Menifee Building&Safety Department 29714 Haun Rd. Menifee, CA 92586 951-672-6777 www.cityofmenifee.us DEPARTMENT OF ENVIRONMENTAL HEALI'i-lf CERTIFICATION OF EXISTING SUBSURFACE DISPOSAL SYSTEM Land Use&Water Resources Western Riverside County Eastern Riverside County 3880 Lemon Street•Suite 200•Riverside•CA•92502 47-950 Arabia Street•Suite A•Indic•CA•92201 Phone:(951)955-8980•Fax: (951)955-8988 Phone: (760)863-7570•Fax:(760)863-7013 Property Infonnati' n: APN: 37 2,-�(1U 6 Date of Inspection: (I -'Z.R - 17 1. Owner: 6 e - k ddress: 3Z Gndenbgr&.2¢- city: ;. e✓� So,r,,�,,r FAILUR TO PROVIDE ALL REQUIRED INFORMATION SHALL PREVENT OWNER FROM OBTAINING - ENVIRONMENTAL HEALTH APPROVAL 2. Show design and location on a scale of 1:20 or 1:40 of the sewage disposal system and 100%expansion area in relation to attached dwellings,structures,wells, rocks,watercourses,etc. 3. a. I examined existing subsurface sewage disposal system at the abo/nvv���e� location on I-2 and determined that the tank capacity is Q Q C7 gallons and that there is sq.ft.of leach line bottom area. There are 3 bedrooms in the dwelling and there are fixture units. ta,j yt C-kR 5 Ca e_jC b. There are 2 leach line(s),each -7 -V_ ft. long. Rock ❑ Plastic Chamber d. There are Seepage pit(s),each in.diameter,and ft.TD. ft. 61 e. The leach bed is ft by It.,total sq.ft.of leached area. 4. a. Construction of septic tank(Please check one of the following): Itconcrete }"' A Fiberglass ❑Steel ❑ Other: b. Internal dimensions of septic: Length $ ft. Width S ft. Depth t 2 ft. c. Condition of tank(please check yes or no for each question): Inlet Tee present? &Yes ❑ No Tank Structure deteriorated? ❑Yes hP�N,Io Outlet Tee present? )@ Yes ❑No Effluent Filter Present? ❑Yes)Ii No Two compartments? 4 Yes ❑No d. Condition of D-Box: Level? Yes ❑ No Replaced? ❑Yes�i1Jo Septic Effluent? ❑Yes No 5. a. While pumping the tank,did effluent flow back into tank from absorption system? ❑Yes PNo b. Prior to pumping,was the liquid level in the tank above the outlet tee? ❑Yes Wo c. Was the area around the lids oxidized? ❑Yes NkNo d. Is design of system gravity feed? Yes ❑No e. Were well(s)observed on this or a jacent property? '6'es ❑No If yes,indicate distance of well from: Septic tank ( ' ft Leach lines to Seepage Pits _ ft. I. Distance from springs,lakes,and natural water courses(check all that apply) ❑ Septic Tank R. ❑ Leach lines ft. ❑Seepage Pits ft. g. Is sewer is within 200 ft.of system and abuts property line? ❑Yes EP'No Additional Comments: h. How long has dwelling been vacant?(f applicable) months weeks ITNIA 6. a. ❑ It is my opinion that the system appears to be in good working order and can be expected to function property with proper maintenance. No repairs are necessary at this time. b. It is my opinion that the system is not in/good working ord.•err a�and will not function properly witho t the following n repairs: Ip� LLJ-03 ?31 r/I!y4 t'w It. CC �001d I certify under pen (Y of peduty that foregor g is true a d correct. r ,, Signature: �_ ly'?- yi �j,�1 IT Print Name: Contractor License No.: ! -N-7 Expiration Date: . 30-j', Pumper Co.: Lj9A'I K Spf7 & G Sp -y 1`t� Phone Number: �S Address: ?O �d x C�Tq y 1 k6 city: '7�.0 P-5. zip Rev.10112 RIVERSIDE CTY/LE ON FACILITY DEPT OF ENTAL HEALTH COUNTTY OF RIVERSIDE 3880 LEMON ST. #200 ;PARTMENT OF ENVIRONI`vIENTAL HEALTH LAND USE APPLICATION OFFICE USE ONLY 1 1/29/201 7 000001 verside•CA•92501-(951)955-8980 PE CODE: FEE: #4421 2:4OPM KATIE0009 io•CA 922oI-pfio)863-757o 02-7ycel, N73 , 722080 $464.00 7 lye LMSN APN: 't 772210 $9.28 USE OF PERMIT: �a #2112 1 4e CA LL,"a ***TOTAL $473- 28 CHECK $473.28 Yl Inv uLw'1 CHANOE $D.DO 2335 �. 1nej4,ekjj9? cityer11 P22 21 Phone 15 _ 0 5- .29 rr_� Email 3 AGENT/ Company Name Agent/Contractor CONTRACTOR: Mairing Addressi Phone Email Si nature Date i PROPERTY INFO: Site Address 3 rcl en ber e )' Cit y-),er1 ,dye W terA Mlell ��� D Lot Size cp L SECTION B Below—For Office Use Only CHECK BOX IF REQUIRED If an box is checked,I—aoplication shall be considered denied until the information is provided. G CeHolding Tank Agreements Required G Floor Plan and/or Plumbing Layout Racidred rtificate of 6d5ling OWTS Required(CA2) C Special Feasibility Boring Report Required G WOCB Clearance Required Detailed Contour Plot Plan Required(1 to 5 foot intervals) Q Soils Percolation Re o rt Required SITE E AL ATIO INSd CTION REI, EHS INITIALS/DATE: SECTION C ❑NEW I fi(REPAIR/REPLACEMENT ❑EXISTING ❑PUMP ❑ATU 1 ❑CONNECT TO SEWER I FIXTURE UNITS: BDRMS s Soils Percolation/Boding Repon By: Oate: Project`-' C 2Cerufication6y: f/ Date:OVA II /28�2f11� Licensed 458�1Li-7 Septic tank cap.: 4� oil Rate: Tested Depth: t Max. trench depth: lobo ab P/X't`si Sq.FL boMn Area: r otal Linear FL: Line(s): q 75 Ca•8 - J�d L'F J Length: 6(5 feet - Each 3 feet wide Sidewall Allowance: FL Rock/ Sq.fL Running foot Rock below drain line: _in. or Xpiastic Chambers Leach Lines'bed special design for slope: ❑WA n Overburden Factor: Pit Diameter. No.pits: Depth below Inlet(bi): Pit Total Depth: Max.allowable depth: ONSTRUCTIO AIMS Ver, TIpN R va- �I�Q ib kl � � a CT � ihi a n SECTION D ' This Application is Approved ❑Denied regarding the design of the OWTS as indicated on the accompanied plot plain using the requirements set forth in Section C above.No constructlorilspermitted In the required reserved 100%Expansion area. EHS Signature: Date: 11121 W DEk SAM22 P.6Y.10114 ot=tLmn:'m.ffE-oacs Fe;YELLOW-exg Deµ PINK-Apph=